With the transformation in modern medical models and the increasingly diversified needs of patients， building a harmonious and mutually trusting doctor-patient community relationship has become the key to improving the quality of medical services， enhancing patients’ sense of access to medical care， and promoting medical effects. Medical social worker is an indispensable member of the medical team， whose interdisciplinary background knowledge and professional skills provide unique advantages for building a harmonious doctor-patient community relationship. However， the current subjects of research on the doctor-patient community are still limited to the medical staff and patients， and there is a lack of relevant research that uses interdisciplinary thinking and tools to explore the path of building a doctor-patient community. Therefore， under the guidance of the spiral research idea of action research method， by sorting out the action paths of medical social workers in carrying out pediatric neurosurgery specialist services in the past five years， three analytical tools from management， namely the strategic decision-making process model， the organization- stakeholder fit model， and the value proposition canvas， were used to solve the problems and dilemmas in the different stages of building a doctor-patient community. On these foundations， practical knowledge was produced， providing valuable experience and methods for medical social workers to build a doctor-patient community.

The professional development of medical social workers currently faces several dilemmas， such as insufficient professionalism， unbroken professional barriers， and an incomplete policy system. To address these dilemmas， medical social workers should clarify the dimensions of their professional capabilities and strive to improve their professional capabilities， building a professional capability framework focusing on problem-solving. Meanwhile， with the popularization of AI technology， the cross-field integration and development of “AI + medical social workers” have brought new opportunities for the professional capability construction of medical social workers. For example， big data can enhance the optimization of electronic health record services； virtual reality （VR） and augmented reality can facilitate the electronic standardization of social worker training for clients； and machine learning can promote the transformation of the social work service model towards “risk prediction and advance intervention，” assisting in improving direct service capabilities. ChatGPT and VR remote consultation systems can be used for supervision services， big data cloud classrooms and robot teaching assistants can broaden learning channels， and natural language processing technology can assist in professional document writing， aiding in enhancing indirect service capabilities. However， applying AI technology to the professional capacity construction of medical social workers may also lead to the alienation of the professional service relationship of medical social workers from needs assessment and relationship building to service intervention， further causing ethical risks brought by demand bias， relationship alienation， and weakened subjectivity. Therefore， it is necessary to rationally view AI’s “double-edged sword” effect. While enjoying the field transformation brought about by high and new technology， it is also imperative to address the subsequent challenges from the perspectives of social work professional assessment and review， educational supervision， and ethical awareness enhancement.

Objective:To investigate the clinical and pathological features of pediatric NTRK-rearranged tumors.Methods:Four NTRK-rearranged soft tissue tumors and one renal tumor at Shanghai Children′s Medical Center, Shanghai Jiaotong University and Singapore KK Women′s and Children′s Hospital from January 2017 to September 2019 were identified. Pan-TRK immunohistochemistry, and the ALK and ETV6 gene break-apart fluorescence in situ hybridizations (FISH) were performed. NTRK gene rearrangement was detected using sequencing-based methods.Results:There were 3 males and 2 females in this study. The patients were between 3 months and 13 years of age. Histologically, the tumors were infiltrative spindle cell tumors with variable accompanying inflammatory cells. Immunohistochemistry showed positive reactivity for pan-TRK in all tumors, with nuclear staining for NTRK3 fusion, and cytoplasmic staining for NTRK1 fusion. The molecular testing revealed NTRK gene fusions (one each of TPM3-NTRK1, ETV6-NTRK3 and DCTN1-NTRK1, and two cases of LMNA-NTRK1). Two patients were receiving larotrectinib. The others were are well without disease, with follow-up durations of 9 to 29 months.Conclusions:NTRK-rearranged mesenchymal tumors from soft tissue sites and kidney are identified. A novel DCTN1-NTRK1 fusion is described. Pan-TRK immunohistochemistry is useful for diagnosis. NTRK-targeted therapy may be an option for unresectable, recurrent or metastatic cases.

Objective To analyze driver genes status and its clinical characteristics of advanced lung adenocarcinoma, then evaluate the status of first-line treatment in a single centric real-world. Methods EGFR, ALK, ROS-1 gene in 204 advanced lung adenocarcinoma tissue were tested by ARMS-PCR method. And the relationship between driver genes status and clinical characteristics was analyzed as the first line treatment in real clinical practice. Results The positive rate of driver genes status in 204 advanced lung adenocarcinoma was 53.9％ (110/204) , including EGFR mutation 46.1％ (94/204) , ALK positive 6.4％ (13/204) and ROS1 positive 1.5％ (3/204). The driving genes status was significantly correlated with gender, smoking history, tumor staging and serosal invasion (P < 0.05). There were significantly differences among the proportion of first-line standard treatment in different subgroup (P = 0.000) , the first-line standard treatment rate of EGFR mutation, ALK/ROS1 positive and drive gene negative were 77.7％, 37.5％, and 46.8％ respectively. And the ratio of using 1 st generation EGFR-TKIs in all patients is 70.6％ (60/85). Conclusion More than half of advanced lung adenocarcinoma have driver genes changes, and EGFR-TKI first-line treatment has higher acceptability in real-word.

Objective To investigate the change of endomucin(EMCN) expression in diabetic retinopathy (DR) and its protective role in neurons apoptosis.Methods Fifty-six clean SD rats were randomly divided into 4 groups,including normal control group with intravitreal injection of normal saline,diabetes mellitus (DM) group with intravitreal injection of normal saline,EMCN transfection group with intravitreal injection of adenovirus associated virus(AAV)-EMCN and mCherry transfection group with intravitreal injection of AAV-mCherry,14 rats for each group.Intravitreal injection was performed 2 weeks before diabetes modeling.Western blot analysis was used to measure the expression of EMCN and phosphorylated Akt (p-Akt)/Akt.Flat-mounted retinas were performed to test the transfection efficiency.Hematoxylin-eosin staining was performed to examine the morphology of retinal tissue.The expression of cleaved caspase-3 in retinas of rats was assayed by immunofluorescence.The retinal apoptotic cells were detected by TUNEL.The use and care of the rats followed the ARVO Statement.Results The levels of fasting plasma glucose were significantly higher in the DM group,EMCN transfection group and mCherry transfection group than those in the normal control group (all at P＜0.001).The expression of EMCN protein at 4 weeks and 8 weeks after modeling in the DM group were significantly lower than that in the normal control group (t=3.71,P＜0.05;t =10.09,P＜0.001).The mCherry transfection group was strongly expressed red fluorescence,the expression of EMCN was significantly lower in retinal tissue of DM group than that in the normal control group (t=13.67,P＜0.001).The expression of EMCN was notably upregulated in retinas of EMCN transfection group,comparing with that of DM group (t =3.18,P＜0.05).The expression of EMCN in mCherry transfection group was similar to that in the DM group (t =2.31,P=0.08).Initial morphologic degenerative changes were found in the DM group and mCherry transfection group,such as inter limiting membrane (ILM) was thicken,the number of RGCs was decreased,and the cells in outer nuclear layer (ONL) and inner nuclear layer (INL) arranged irregularly.The histologic change of retinas in the EMCN transfection group was milder than that in the DM group.The expression of cleaved caspase-3 was upregulated in INL of DM group and mCherry transfection group,compared with that in the normal control group.Compared with the normal control group,the number of TUNEL-positive cells noticeably increased in the ONL of DM group and mCherry transfection group,and the number of TUNEL-positive cells markedly reduced in the EMCN transfection group.The relative expression of p-Akt/Akt was significantly lower in the retinal tissue of DM group than that in the normal control group (t =5.52,P＜0.01).However,the relative expression of p-Akt/Akt was notably upregulated in retinas of EMCN transfection group,compared with that in the DM group (t=3.14,P＜0.05).The relative expression of p-Akt/Akt in mCherry transfection group was similar to that in the DM group (t =0.81,P =0.46).Conclusions The overexpression of EMCN can protect diabetic retinas neurons from apoptosis,and its mechanism maybe associated with activation of Akt signaling pathway.

Objective: To investigate the effect of mesenchymal stem cells (MSCs) on apoptosis of breast cancer cell line MCF-7 induced by cisplatin (DDP), MSCs derived from breast cancer (BC-MSCs) or adjacent non-cancerous tissues (BN-MSCs) were isolated, cultured and identified. Methods: BC-MSCs and BN-MSCs were isolated and cultured by tissue adherent method. The differentiation potential of BC-MSCs was detected by osteogenic and adipogenic induction, and cell surface markers of BC-MSCs and BN-MSCs were evaluated by flow cytometry. MCF-7 cells were co-treated with DDP and conditioned medium (CM) collected from BC-MSCs and BN-MSCs after being cultured for 48 hours, respectively. Inhibition rate of cell proliferation was evaluated by MTT. Cell apoptosis and viability were detected by MUSE cell analyzer. Cytokines in MSC-CM were detected by Luminex liquid chip. Interleukin 6 (IL-6) mRNA expressions in MCF-7 cells with different treatment were detected by RT-PCR. Results: The morphology of BC-MSCs and BN-MSCs successfully isolated and cultured was uniform fibroblast-like clusters under the microscope. These cells expressed high levels of CD29 and CD44, but neither CD14 nor CD34 were detected. MSCs could also differentiate into osteoblasts and adipocytes after specific induction. After treatment with 2.5, 5, 10, 20, 40 and 80 μmol/L DDP, the inhibitory rates of proliferation of MCF-7 cells in DDP group were (17.33±2.00)%, (22.37±0.73)%, (30.77±1.23)%, (44.93±1.27)%, (62.03 ±1.97)% and (73.93±1.10)%, respectively. While the inhibitory rates of DDP+ BC-MSCs group were (8.27±0.63)%, (11.50±1.30)%, (20.57±0.93)%, (32.60 ±1.90)%, (52.27±0.73)% and (62.13±2.17)%, respectively. The inhibitory rates of DDP+ BN-MSCs group were (12.90±1.60)%, (16.53±2.87)%, (25.90±1.50)%, (39.40±2.40)%, (57.40±0.70)% and (69.03±1.07)%, respectively. The inhibitory rates of DDP+ BC-MSCs group were significantly lower than those of DDP group (P<0.05). The apoptotic rates of MCF-7 cells in DDP group, DDP+ BC-MSCs group and DDP+ BN-MSCs group were (47.77±1.98)%, (29.20±2.12)% and (37.92±2.21)%, respectively. The apoptotic rates of DDP group was significantly higher than that of DDP+ BC-MSCs group (P<0.05). The cell viabilities of MCF-7 in DDP group, DDP+ BC-MSCs group and DDP+ BN-MSCs group were 0.52±0.02, 0.72±0.02 and 0.64±0.02, respectively. The cell viability of DDP group was significantly lower than that of DDP+ BC-MSCs group (P<0.05). The result of Luminex liquid chip analysis showed that, the level of IL-6 in BC-MSCs group increased 2.50±0.68 fold when compared with BN-MSCs group (P<0.05). The relative expressions of IL-6 mRNA in DDP group and DDP+ BC-MSCs group were 1.02±0.10 and 7.58±0.55, respectively, with a statistically significant difference (P<0.01). The apoptotic rates of MCF-7 cells in DDP+ BC-MSCs group with or without IL-6 neutralizing antibody were (27.41±1.95)% and (42.45±2.87)%, respectively, with a statistically significant difference (P<0.05). The cell viabilities of MCF-7 cells in DDP+ BC-MSCs group with or without IL-6 neutralizing antibody were (72.40±2.60)% and (59.76±3.89)%, respectively, with a statistically significant difference (P<0.05). Conclusions BC-MSCs and BN-MSCs have been isolated and cultured successfully. Compared with BN-MSCs, BC-MSCs could attenuate the effect of DDP on MCF-7 cells, evidently decrease the apoptosis and increase the proliferation and vitality in an IL-6 dependent manner.

Objective To investigate the expression of helper T cells (Th)17/regulatory T cells (Treg) balance associated factors in rheumatoid arthritis (RA) patients and their correlation with serum midkine (MK).Methods A total of 60 RA patients were divided into active RA patients (n=32) and inactive RA patients group (n=28).MK level in sera was detected by enzyme linked immunosorbent assay (ELISA) in 60 patients with RA and 30 healthy controls (HCs).The fraction of CD4+CD25+FOXP3+ Treg cells and IL-17+CD4+ Th17 cells in RA patients and healthy controls were determined by flow cytometry (FCM), and the expreasion of Foxp3, RORγt, Signal transducer and activator of transcription (STAT) 3 and STAT5 mRNA were detected with real-time polymerase chain reaction (PCR).Results were evaluated using ANOVA followed by q tests for comparisons of Th17 population between active RA patients, inactive RA patients and HCs, t test was used for comparing of Foxp3, RORγt, STAT3, STAT5 mRNA between RA group and HCs.The correlations between serum MK concentration and peripheral Treg cells, Th17 cells, Foxp3, RORγt, STAT3, STAT5 mRNA were analyzed by Pearson's correlation analysis.Results The percentages of Treg cells from active RA patients, inactive RA patients and HCs were significantly different (F=129.6, P＜0.01), the percentages of Treg cells of active RA patients [(1.41±1.05)％] were lower than that of the inactive RA patients [(3.6±1.6)％;q =7.92, P＜0.05] and healthy group [(7.7±1.7)％;q=22.45, P＜0.05], and there was significant difference between healthy group and inactive RA group (q=14.53, P＜0.05).The percentages of Th17 cells of the three groups were also significantly different (F=36.3, P＜0.01),the percentage of Th17 cells of active RA patients [(1.84±1.01)％] was significantly higher than that of inactive RA patients [(0.71±0.28)％;q=9.59, P＜0.05] and healthy group (0.53±0.16)％ [(P＜0.05;q=1 1.10, P＜0.05], there was no significant difference between the inactive RA group and healthy group (q=1.51, P＞0.05).The expression of RORγt and STAT3 mRNA in RA patients was higher than that of healthy controls (t=5.84, P＜0.01;t=4.52, P＜0.01).The expression of Foxp3 and STAT5 mRNA in RA patients were lower than healthy controls (t=6.01, P＜0.01;t=2.18, P＜0.05).Serum MK values were correlated with STAT5 (r=-0.55, P＜0.01), but not with Foxp3, RORγt, STAT3 mRNA or the percentage of Treg/Th17 cells.Conclusion Serum MK expression and the percentage of Th17 cells increase, while the percentage of Treg cells decrease in RA patients.Serum MK values are negatively correlated with STAT5 mRNA which is associated with Th17/Treg balance.This may be important in the pathogenesis of RA.

Objective To investigate the effects ofneutrophils alkaline phosphatase (NAP) on the migration,reactive oxygen species (ROS) generation and apoptosis of neutrophil-like differentiated HL-60 cells.Methods NAP was overexpressed in HL-60 cells via transfecting coding sequence of NAP by lentivirus.The effectivity of NAP overexpression was confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting.HL-60 cells were differentiated into neutrophil-like cells by exposure to 1.5％ DMSO.The migration and ROS generation of neutrophil-like cells with NAP overexpression were detected by transwell migration test and flow cytometry,respectively.Cell apoptosis were detected by flow cytometry.The expression of apoptosis-related protein Bax,caspase-3 and caspase-9 in neutrophil-like cells were observed by Western blotting after NAP overexpression.Results Over 80％ HL-60 cells presented green fluorescence after GFP-NAP infection by lentivirus and screening by puromycin.In addition,the levels of both gene and protein of NAP were up-regulated in these cells.After 5-day culture with 1.5％ DMSO,the bulk of induced cell was smaller and the surface appeared many bumps and irregular shape.The ratio of nuclear and cytoplasmic decreased and nucleolus disappeared.The nuclear chromatin changed from dense to loose and the nuclear morphology appeared to be rod and segmented.The percentage of CD1 lb+ cell increased from 26.25％ to 98.55％.The transwell migration test showed that the number of migrated cells was higher in neutrophil-like cells with NAP overexpression compared with the negative control [(15.30±3.65) × 103 vs (8.00±0.78) × 103] (P＜0.001).Results of flow cytometry suggested that the mean fluorescence intensity (MFI) of intracellular ROS was significantly higher in neutrophil-like cells with NAP overexpression compared with the negative control (355.70±20.10 vs 103.22±4.71) (P＜ 0.001).In addition,Western blotting showed that the expressions of apoptosis-related protein Bax,activecaspase-3 and active-caspase-9 were all up-regulated in neutrophil-like cells with NAP overexpression compared with the negative control.Conclusion NAP could promote the migration and ROS generation of neutrophil-like cells and accelerate the cell apoptosis.

Background and purpose:Recently, studies showed that non-steroidal anti-inlfammatory drugs (NSAIDs) could reduce the incidence of cancer. Whether ibuprofen could inhibit the growth of hepatocellular carcinoma cells had not been reported yet. In the current study, we investigated the effects of ibuprofen on hepatoma carcinoma BEL-7402 cells and the relevant mechanisms. Methods: Hepatocellular carcinoma BEL-7402 cells were randomly divided into 7 groups:the control group and the ibuprofen groups (0.1, 0.5, 1.0, 2.0, 3.0 and 4.0 mmol/L). The effect of ibu-profen on BEL-7402 HCC cells was measured by MTT method, the cell cycles were analyzed by flow cytometry (FCM), cell vitality and apoptosis were determined by cell analyzer. PCNA, Cyclin D1, Bcl-2 and COX-2 protein levels were examined by Western blot, and the expressions of prostaglandin E2 (PGE2) were measured by ELISA. Results:After the exposure to ibuprofen, the suppression ratio of BEL-7402 cells was increased (P<0.05). BEL-7402 cell vitality was decreased by degrees significantly (P<0.05), early apoptosis of BEL-7402 cells was increased (P<0.05), and the G0/Gl phase ratio was increased significantly compared with control group (P<0.05). Ibuprofen effectively decreased PCNA, Cyclin D1, Bcl-2 and COX-2 expressions in BEL-7402 cells (P<0.05), and decreased PGE2 protein expression in cell culture supernatants sig-nificantly (P<0.05). Conclusion:Ibuprofen is effective for inhibiting the proliferations, increasing apoptosis and blocking cell cycles of BEL-7402 HCC cells. The anti-tumor mechanisms of ibuprofen may be related with the inhibition of COX-2 and PGE2 expressions.

Objective To evaluate the detection of membrane neutrophilic alkaline phosphatase ( mNAP) by flow cytometry in diagnosis of bloodstream infection .Methods A total of 298 patients with suspected bloodstream infections admitted in the First People ’ s Hospital of Lianyungang during June 2013 and October 2014 were enrolled;80 healthy subjects in physical examination center were also enrolled as the control group.Bloodstream infection was diagnosed by blood culture and mNAP was detected by flow cytometry.Serum levels of procalcitonin (PCT) and C-reactive protein (CRP) were detected by electro-chemiluminescence (ECL) and immune scatter turbidimetry , respectively.The value of mNAP, PCT and CRP in diagnosing bloodstream infection was determined by receiver operating characteristic ( ROC) curve. Results Among 298 patients, 109 were confirmed with bloodstream infections , including 43 patients with Gram-positive bacterial infections and 66 with Gram-negative bacterial infections .The median levels of CRP , PCT and mNAP in bloodstream infection group were 138.71 mg/L, 7.04 ng/mL and 13 929 AB/c, which were significantly higher than those in healthy control group (1.50 mg/L, 0.12 ng/mL, 1 831 AB/c;U=5.00, 48.50 and 65.01, P<0.01).The expression of mNAP in Gram-positive bacterial infection group was 9 598 ( 6 064-11 643 ) AB/c, which was significantly lower than that in Gram-negative bacterial infection group [16 512 (11 654-22 001) AB/c] (U=250.00, P<0.01).ROC curve analysis showed that, the areas under the curve (AUCs) of mNAP, PCT and CRP in diagnosing bloodstream infection were 0.987, 0.962 and 0.901.When 4 578AB/c, 0.90 ng/mL and 13.50mg/L were taken as optimal cut-off values, the sensitivities of mNAP, PCT and CRP in diagnosis of bloodstream infection were 95.8%, 93.0%and 90.3%; the specificities were 97.8%, 95.6% and 85.5%, respectively.Conclusion Among mNAP, PCT and CRP, mNAP is of the highest value in diagnosing bloodstream infection , and may be used as a biomarker for clinical diagnosis of bloodstream infection .